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RF-17-523ACB2 Engineering Inc. Testing & Engineering Services Certification of Authorization # 8131 Tel: 954-245.8976; Fax: 954.301.7776 5230 NE 18 Avenue Fort Lauderdale, FL 33334 9NC,1b - 84 2 Roof Tile Uplift Test Report Attention: Miami Shores Village, Building Division, 10050 NE 2nd Avenue, Miami Shores, FL 33138 Client: E -Z General Test Date: 5/3/2017 Permit # RF -2-17-523 Property Address. Comerford Residence 10565 NE 2 Court, Miami Shores, FL Roof Pitch: Type of Tile: Roof Area: 3 in 12 Concrete Roof Tile 13.00 squares Tile Attachment Method: Two Component Polyurethane Foam Adhesive -Poly Pro H 160 Field Instrument : IMADA Force Gauge 0-100 Serial number: 243454 Test Location Perimeter Area: Field Area: No. of Corner: Ridge Areas: (T1-T6) 6.00 sq. (T7 -T13) 7.00 sq. (T14 -T17) 4 (T18 -T29) 120 pcs. Total Number of Tests 6 7 4 12 Important: Field Uplift Pull Test Test results As per FBC 2014 As per FBC 2014 As per FBC 2014 As per FBC 2014 Passed Passed Passed Passed These laboratory results can change due to future weather impacts and/or unavoidable roof traffic. Therefore, this report represents the TAS 106 results at the time of the test. Please see attached a Roof Sketch for this project. Cordiall ACB2 _tiering Inc. (NOA 09-1005.01) Anto !Acevedo, PE Fla. Reg. No: 36466 513/2,0(7 ACB2 Engineering Inc. Engineering and Laboratory Services 5230 NE 18th Avenue Fort Lauderdale, Florida 33334 Phone: (954) 245-8976 Fax: (954) 301-7776 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number Expiration: 09/09/2017 Applicant 10565 NE 2 Court Miami Shores, FL 1122310130590 Block: Lot: YORNET AND SAMUEL COMERI Owner Information Address Phone Cell YORNET AND SAMUEL COMERFORD 10565 NE 2 Court MIAMI SHORES FL 33138- (305)751-7467 10565 NE 2 Court MIAMI SHORES FL 33138- Contractor(s) Phone E -Z GENERAL & ROOFING cONTRAC' (954)418-8640 CeII Phone Valuation: Total Sq Feet: $ 8,500.00 1300 Type of Work: Re Roof Additional Info: NEW ROOF AT ADDITION AND TIE INS Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - New Roof Scanning Fee Technology Fee Amount $5.40 $4.13 $4.13 $1.80 $275.00 $3.00 $7.20 Total: $300.66 Pay Date Pay Type Invoice # RF -2-17-63103 03/13/2017 Check #: 1552 $ 300.66 $ 0.00 Amt Paid Amt Due Available Inspections: Inspection Type: Up Lift Report Tin Cap Final Roof Tile In Progress Renailing Affidavit Review Roof Review Roof Cap Sheet In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and z uthermore,ze the above-named contractor to do the work stated. March 13, 2017 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date March 13, 2017 1 CakeervA 2-191)41 BUILDING PERMIT APPLICATION ❑ BUILDING ❑ ELECTRIC Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 aoZ g OA CI3M333?:1 FBC 20195 Master Permit No. gc --4 6-- 642_, Sub Permit No. er 1 — 5l3 ROOFING ❑ REVISION ❑ EXTENSION ❑ PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CONTRACTOR ❑ RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS JOB ADDRESS: 15 (PC /v 6 ,9 emir -4 . City: Miami Shores �3 County: Miami Dade Zip: 33/3T Folio/Parcel#: 1 i 2a13( -O( 3-0690 Is the Building Historically Designated: Yes NO __ BFE: FFE: Occupancy Type: Load: Construction Type: Flood Zone: OWNER: Name (Fee Simple Titleholder): Address: t DJC ( 5 `A' b ?.Q4 D �. city: Lc,ti \► S- State: Tenant/Lessee Name: Email: Nei Phone#: 1J 4» 1,6z- zip: 331-2)F Phone#: CONTRACTOR: Company Name: G–t- C--,B,PlJ t v<U ciFi f 9 if 1' `d Phone#: Address: LI / 5-( /i 6' 3 &Veil ae_ �J City: CbJaq-nd State: F(_ P. ®ko State Certification or Registration #: 0.00_ L 5b2 Certificate of Competency #: Qualifier Name: • • Zip: ( 3 Phone#: q.5-4/1/1$ F424(3 DESIGNER: Architect/Engineer: Address: Value of Work for this Permit: $ Type of Work: ❑ Addition Description of Work: Arreitk� Phone#: p p�-� City: State: Zip: «5V0 GA:* Square/Linear Footage of Work: / �jt9d 5 ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition R8/ na o -ii *)7 d )415, Specify color of c • Submittal Fee $ Scanning Fee $ for thru tile: Zv Permit Fee $ CCF $ o, ' ® CO/CC $ �— Radon Fee $ q • Technology Fee $ Structural Reviews $ (Revised02/24/2014) DBPR $ (-i • 13 Notary $ Training/Education Fee $ <" )Double Fee $ Bond $ TOTAL FEE NOW DUE $ a EXU Bonding Company -lame (if applicable) Bonding Con4any's ddress City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address i City State a I Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the ' -nce of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature OWNER or AGENT The foregoing ihusirument was acknowledged before me this • 1 day of " ' , 20 17 , by LAP o\ (� i , who is personally known to Signature CONT The foregoing instrument wa acknov✓ ged before me this a day of (CrE` 20 ' / , by A)C1 n, OiUj) , who is personally known to me or who has produced as me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: vv ���a�;,° •c LAURA F MY COAM1lISSION # FF 188027 EXPIRES: Marsh 16, 2019 444opo f Banded Thio Budget Notary Sem ********•****************'a******* ***************** APPROVED BY * identification and who did take an oath. NOTARY PUBLIC: as Plans Examiner ************** Zoning Structural Review Clerk (Revised02/24/2014) Master Permit No. RECEIVED FEB 2 8 2017 Florida Building Code 5th Edition (2014) ROOF ASSEMBLIES AND ROOFTOP STRUCTURES High -Velocity Hurricane Zone Uniform Permit Application Form. itc,3 Sect A G feral Information) • Contractor's Name -6-2- let7J Cid1 5(i-ra�� — 4 i� `! Process No. 1 1 1 1 Job Address 1 D54/..,5"-- .4 6 Ok ❑ Low Slope ❑ Asphaltic Shingles ROOF CATEGORY ❑ Mechanically Fastened Tile ❑ Metal Panel/Shingles ❑ Prescriptive BUR -RAS 150 ROOF TYPE Mortar/Adhesive Set Tiles 0 Wood Shingles/Shakes 1 1 1 1 1 New roof repair 0 Maintenance ❑ Reroofing 0 Recovering 1 ROOF SYSTEM INFORMATION 1 Low Slope Roof Area (SF) Y. Steep Sloped Roof AREA (SSF) 11-60 otal (SF) //MO 1 1 II Section B (Roof Plan)• • 1 Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflour drains, Jndhde dimen-' g sions of sections and levels, clearly identify dimensions of elevated pressure zones and location (*ar ts. : •. • • ...6:. •••• • • • •• • • • • • •• •• • EN immommaiiimmorrountordillin MERE 11111111111111111111111•11111MiliaM 1101111111111111 ill K. MEE lima . „ klail iirb •0 •• • 1 • ••• • •••I•• !" FLORIDA BUILDING CODE — BUILDING, 5th EDITION (2014) 15.37 Copyright to, or licensed by, ICC (ALL RIGHTS RESERVED); accessed by Ellerin- Palacio on Jun 8, 2015 10:32:12 AM pursuant to License Agreement. No further reproductions authorized. INTERNATIONAL CODE COUNCIL 1 1 1 I 1 I 1 I 1 ROOF ASSEMBLIES AND ROOFTOP STRUCTURES Florida Building Code 5th Edition (2014) High -Velocity Hurricane Zone Uniform Permit Application Form Section D (Steep Sloped Roof System) Lt4A 16— iII�� Roof System Manufacturer: Notice of Acceptance Number. Minimum Design Wind Pressures, If Applicable (From RAS 127 or Calculations): P1: P1: P1: RISlope: /� :12 Ridge Ve dation? Deck Type: /7 cOs. P1 -4(4000P Type Underlayment Insulation: r5O4 Fir Fire Barrier: 014 Fastener Type & Spacing: Adhesive Type: Type Cap Sheet: NIR •••• • • row 6-...ki.6•6F...4 Mean Roof Height: )9 a IO " p0�:;�pu�c. •• Roof Covering: COIN LigiW► v .. . . Type & Size Drip Edge: • • • • A,I• • • • ' •• • • • .. • •. 00 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 •' • . 1 • 1.•.• i•••• 1 • 1 1 1 FLORIDA BUILDING CODE — BUILDING, 5th EDITION (2014) 15.39 Copyright to, or licensed by, TCC (ALL RIGHTS RESERVED); accessed by Eliezer Palacio on Jun 8, 2015 10:32:12 AM pursuant to License Agreement. No further reproductions authorized. INTERNATIONAL CODE COUNCIL' SECTION 1524 HIGH VELOCITY HURRICANE ZONES — REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS 1524.1 Scope. As it pertains to the section, it is the responsibility of roofing contractor to provide the owner with the required roofing permit, and to explain to the owner the content of the section. The provisions of Section R4402 govem the minimum requirements and standards of the industry for roofing system installations. Additionally, the following items should be addressed as part of the agreement between the owner ant the contractor. The owner's initial in the designated space indicates that the item has been explained. 2. be con Renailing wood decks: When replacing roofing, the existing wood roof deck may have to ailed in accordance with the current provisions of Section R4403. (The roof deck is usually led prior to removing the existing roof system). 4. %i Exposed Ceiling: Exposed, open beam ceilings are where the underside of the roof decking ca ewed from below. The owner may wish to maintain the architectural appearance; therefore, roo�! nail penetration of the underside of the decking may not be acceptable. Thisrovides the option of maintaining the appearance. p •••• • • ..•• • .• • •• . .. . • • 6. ��1 Overflow scuppers (wall outlets): It is required that rainwater flow's o f'so that the rtkf is • not ;1-r ded from a buildup of water. Perimeter/edge wall or other roof extens`op r1ay bloc�C this discge if overflow scuppers (wall outlets) are not provided. It may be ecesstillo.itstall oyerFIp scuppers in accordance with the requirements of Sections R4402, R and 1441.1. .. . •• • gent's Sign.? re V a ,) Property Address Revised on 7/9/2009 LD;07/01/2015; Contractor Sign . •. • Date •. . ••• • •. •• 12. C- 16 -6-0 Permit Number . . • . • MIAMMA� I 0 DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES (RER) BOARD AND CODE ADMINISTRATION DIVISION NOTICE OF ACCEPTANCE (NOA) Boral Roofing, LLC 7575 Irvine Center Drive, Suite 100 Irvine, CA 92618 MIAMI-DADE COUNTY PRODUCT CONTROL SECTION 11805 SW 26 Street, Room 208 Miami, Florida 33175-2474 T (786) 315-2590 F (786) 315-2599 www.miamidade.gov/economy SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The documentation submitted has been reviewed and accepted by Miami -Dade County RER - Product Control Section to be used in Miami -Dade County and other areas where allowed by the Authority Having Jurisdiction (AHJ). This NOA shall not be valid after the expiration date stated below. The Miami -Dade County Product Control Section (in Miami -Dade County) and/or the AHJ (in areas other than Miami -Dade County) reserve the right to have this product or material tested for quality assurance purposes. If this product or material fails to perform in the accepted manner, the manufacturer will incur the expense of such testing and the AHJ may immediately revoke, modify, or suspend the use of such product or material within their jurisdiction. RER reserves the right to revoke this acceptance, if it is determined by Miami -Dade County Product Control Section that this product or material fails to meet the requirements of the applicable building code. This product is approved as described herein, and has been designed to comply with the Florida Building Code including the High Velocity Hurricane Zone of the Florida Building Code. DESCRIPTION: Boral Villa 900 Concrete Roof Tile •• ... . LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state . ate an 1. olbwing statement: "Miami -Dade County Product Control Approved", unless otherwise noted herein. . • • • • RENEWAL of this NOA shall be considered after a renewal application has been filed andtfiere jias been na change• in the applicable building code negatively affecting the performance of this product. •••• • • • TERMINATION of this NOA will occur after the expiration date or if there has been a reviSioteor change int the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorse3d'eit of any Product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply witk•aay.section of this NOA shall be cause for termination and removal of NOA. •• ••• •• ••• • • • . • • • • ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This NOA renews NOA No.12-0308.20 and consists of pages 1 through 7. The submitted documentation was reviewed by Alex Tigera. MIAMI.DADE COUNTY APPROVED NOA No.: 16-0711.04 Expiration Date: 09/21/21 Approval Date: 09/01/16 Page 1 of 7 . ROOFING ASSEMBLY APPROVAL Category: Roofing Sub Category: Roofing Tiles Material: Concrete 1. SCOPE This renews a system using Boral Villa 900 Concrete Roof Tile, as manufactured Boral Roofing, LLC in Lake Wales, FL and described in Section 2 of this Notice of Acceptance. For locations where the pressure requirements, as determined by applicable Building Code, do not exceed the design pressure values obtained by calculations in compliance with RAS 127 using the values listed in section 4 herein. The attachment calculations shall be done as a moment based system. 2. PRODUCT DESCRIPTION Manufactured by Applicant Dimensions Boral Roofing Villa 900 Length = 17" Width = 13" %2" thick Trim Pieces 1= varies w = varies varying thickness Test Product Specifications Description TAS 112 Low profile, interlocking, high pressure extruded Type lb concrete roof tile equipped with three nail holes Class III and double rolls. For direct deck, batten, mortar or adhesive set applications. TAS 112 Accessory trim, concrete roof pieces for use at ridges, hips and rakes. 2.1 PRODUCTS MANUFACTURED BY OTHERS Product Name Product Description ICP Adhesives Polyset AH -160 ICP Adhesives Polyset RTA -1 TILE BONDTM Roof Tile Adhesive Single component polyurethane foam roof tile adhesive. "Tile Tite" Roof Tile Mortar Two component polyurethane foam adhesive. Single component polyurethane foam roof tile adhesive. Premixed, pre -bagged roof tile mortar. 2.2 MANUFACTURING LOCATION 2.2.1. Lake Wales, FL MIAMI-DADE COUNTY APPROVED • • • • • .• • • .•• • • •••• •. • •• . • • Manufacturer • • • • (WitI_arrrgnt NQA, • • • • •ICP AdhesL,e,s, qd Sea• lapis, Inc. • • • • • ••• •• ••• . ICP Adhesives** Sealants, Inc. • . • • The Dow atemical Company • Bermuda Roof Co. Inc. • . .•• • NOA No.: 16-0711.04 Expiration Date: 09/21/21 Approval Date: 09/01/16 Page 2 of 7 • 2.3 EVIDENCE SUBMITTED Test Agency Nutting Engineers Redland Technologies Redland Technologies Redland Technologies The Center for Applied Engineering, Inc. The Center for Applied Engineering, Inc. Redland Technologies Redland Technologies The Center for Applied Engineering, Inc. The Center for Applied Engineering, Inc. The Center for Applied Engineering, Inc. Celotex Corporation Testing Services Walker Engineering, Inc. Walker Engineering, Inc. Walker Engineering, Inc. Walker Engineering, Inc. Walker Engineering, Inc. Walker Engineering, Inc. Walker Engineering, Inc. American Test Lab of South Florida MIAMIFDADE COUNTY APPROVED Test Identifier 13343.1 7161-03 Appendix III 7161-03 Appendix II P0402 94-060B 94-084 P0631-01 Letter Dated Aug. 1, 1994 Project No. 307025 Test #MDC -76 25-7183-1 25-7183-2 25-7214-2 25-7214-6 528454-2-1 520109-2 Evaluation Calculations Evaluation Calculations Evaluation Calculations Evaluation Calculations Evaluation Calculations Evaluation Calculations Evaluation Calculations RT0617.02-16 Test Name/Report TAS 112 Static Uplift Testing TAS 102 & TAS 102(A) Wind Tunnel Testing TAS 108 (Nail -On) Withdrawal Resistance Testing of screw vs. smooth shank nails Static Uplift Testing TAS 101 (Adhesive Set) Static Uplift Testing TAS 101 (Mortar Set) Wind Tunnel Testing TAS 108 (Mortar Set) Wind Tunnel Testing TAS 108 (Nail -On) Wind Driven Rain TAS 100 Static Uplift Testing TAS 102 (2 Quik -Drive Screws, Direct Reut Static Uplift Testing TAS 102 (1 Quik -Drive Screw, Direct Ieg k4 (1 Quik -Drive Screw, Bat#sl„ Static Uplift Testing' • • • TAS 101 . . • •• • 25-7183 25-7094 25-7496 25-7584 25-7804b-8 25-7804-4 & 5 25-7848-6 • • • . • .• • Aerodynamic Multipliers Two Patty Adhesive Set System Restoring Moment Due to Gravity TAS 112 Date Apr. 2006 Dec. 1991 Dec. 1991 Sept. 1993 March, 1994 May 1994 July 1994 Aug. 1994 Oct. 1994 Feb. 1995 •..• ..•. V. Melareh,1995 . •. . • • . . •• .. .. • •Sep?1998 Det. 1998 lVlIMI.1' 1995, 1'e1*t* 1996 April 1996 December 1996 09/01/16 April 1999 09/01/16 06/29/16 NOA No.: 16-0711.04 Expiration Date: 09/21/21 Approval Date: 09/01/16 Page 3 of 7 3. LIMITATIONS: 3.1 Fire classification is not part of this acceptance. 3.2 For mortar or adhesive set tile applications, a static field uplift test shall be performed in accordance with TAS 106. 3.3 Applicant shall retain the services of a Miami -Dade County Certified Laboratory to perform quarterly test in accordance with TAS 112, appendix 'A'. Such testing shall be submitted to the Building Code Compliance Office for review. 3.4 Minimum underlayment shall be in compliance with the applicable Roofing Applications Standards listed section 4.1 herein. 3.5 30/90 hot mopped underlayment applications may be installed perpendicular to the roof slope unless stated otherwise by the underlayment material manufacturers published literature. 3.6 This acceptance is for wood deck applications. Minimum deck requirements shall be in compliance with applicable building code. 4. INSTALLATION 4.1 Villa 900 Concrete Roof Tile and its components shall be installed in strict compliance with Roofing Application Standard RAS 118, RAS 119, and RAS 120. 4.2 Data For Attachment Calculations Table 1: Average Weight (W) and Dimensions (I x w ) Table 2: Aerodynamic Multipliers - X (ft3) • • Tile 4":12" Tile Profile Weight -W (Ibf) Length -I (ft) Profile Direct Deck Width -w (ft) .... • Direot.Deck A lication . .; Villa 900 Concrete Tile 10.90 1.42 :IDA • • • •• 'i.b$• • • • .. . • • ... • Table 3: Restoring Moments due to Gravity - M9 (ft-Ibf3 •' • •' Table 2: Aerodynamic Multipliers - X (ft3) • • Tile 4":12" X (ft3) ••••••X (ft . Profile Direct Deck Batten Application Direot.Deck A lication . .; Villa 900 Concrete Tile Direct Deck 0.291 ••••••0.31 ••••• ••• • ... • Table 3: Restoring Moments due to Gravity - M9 (ft-Ibf3 •' • •' Tile Profile 2":12" 3":12" 4":12" 5":12" 6":12" • 11• •7v112" or •.." grVater Villa 900 Concrete Tile Direct Deck Direct Deck Battens Direct Deck Battens Direct Deck Battens Direct Deck Battens Direct Deck 7.70 7.62 6.56 7.50 6.42 7.34 6.26 7.15 6.08 6.95 MIAMI.DADE COUNTY APPROVED NOA No.: 16-0711.04 Expiration Date: 09/21/21 Approval Date: 09/01/16 Page 4 of 7 • .. • .. • .• •• •• Table 4: Attachment Resistance Expressed as a Moment - Mf (ft-Ibf) for Mechanically Fastened Systems Tile Profile Fastener Type Direct Deck (min 15/32" plywood) Direct Deck (min. 19/32" plywood) Battens Villa 900 Concrete Tile 2-10d Ring Shank Nails 27.8 37.4 28.8 1-10d Smooth or Screw Shank Nail 8.8 11.8 4.1 2-10d Smooth or Screw Shank Nails 16.4 21.9 7.1 1 #8 Screw 25.8 25.8 22.9 2 #8 Screw 47.1 47.1 49.1 1-10d Smooth or Screw Shank Nail (Field Clip) 24.3 24.3 24.2 1-10d Smooth or Screw Shank Nail (Eave Clip) 19.0 19.0 22.1 2-10d Smooth or Screw Shank Nails (Field Clip) 35.5 35.5 34.8 2-10d Smooth or Screw Shank Nails (Eave Clip) 31.9 31.9 32.2 Table 5: Attachment Resistance Expressed as a Moment Mr (ft-Ibf) for Two Paddy Adhesive Set'Systems Tile Profile Tile Application Minimum Attachment Resisitariee° Villa 900 Concrete Tile Adhesive' : ., °. 26.1"••• • • 1 See foam adhesive manufacturer's component approval for installation requirements. °° : 5. LABELING 5.1 All tiles shall bear the imprint or identifiable marking of the manufacturer's name or logo as detailed below, or following statement: "Miami -Dade County Product Control Approved". LABEL FOR BORAL VILLA 900 CONCRETE TILE (LOCATED ON THE UNDERSIDE OF TILE) 6. BUILDING PERMIT REQUIREMENTS: 6.1 Application for building permit shall be accompanied by copies of the following: 6.1.1 This Notice of Acceptance. 6.1.2 Any other documents required by Building Official or Applicable building code in order to properly evaluate the installation of this system. MIAMI•DADE COUNTY APPROVED • • • • + • • •0•• •• • •. • •• • 0 • •• • • • • • • •••• •• • • • • • • • • •••• • •• • • •• •• • • • • • • • •• • • • • • • • • • • • • • •• • • • • • • • • • ••• • • • NOA No.: 16-0711.04 Expiration Date: 09/21/21 Approval Date: 09/01/16 Page 6 of 7 PROFILE DRAWING 21/8" VILLA 900 CONCRETE ROOF TILE END OF THIS ACCEPTANCE MIAMFDADE COUNTY APPROVED • • • •. ..• • •••• •••• • • •• •• • • • • • • • • • • •• • fi .•• •• •••• •• • •• • • •• • •• • • • • • .• •• • • • • •• • • • • • ••• • • •• •• • • • • a •• • • • • NOA No.: 16-0711.04 Expiration Date: 09/21/21 Approval Date: 09/01/16 Page 7 of 7 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795. Fax: (305) 756.5 f'1-2017 ^rc -: _ 'o: 17-523 1. Provici product approval for the underlayment and 2. specify' the color of the color-thru roof tile to be use 2. Pier, make sure that the villa the is a color-thru til suction E tile calculations. •::;,j0, BO, CFM 1— 69-b— -rn9-criD /7- is /9 eoL. ote 7--)ttoc6ci‘- /9-77-firdio ( niAr 6/9-7,6 0 -g -4 -24 -vi") �� ^ the foam. d.) } e. ...••• .• . •••. • .. ...• •••• . •. • • /foodcr /q,,,x4v,; ••••. ••••• 0• • •..••• •' 00000 000000 ROOF ASSEMBLIES AND ROOFTO S T ES?:E ^ f a tia , n9 High -Veto �:: fjn r pplication Form. Section E (Tile Calculations) For Moment based tile systems, choose either Method 1 or 2. Compare the values for Mr with the values from Mf. If the M, values are greater than or equal to the M, values, for each area of the roof, then the tile attachment method is acceptable. Method 1 "Moment Based Tile Calculations Per RAS 127" (P1:_ x A _ = ) - Mg: = Mr, Product Approval M, (P2:x?. = ) - Mg: = M,, Product Approval Mr (P3:xA = ) - Mg: = Ma Product Approval M, RECEIVED MAR 0 6 2017 Method 2 "Simplifi T'le alculations Per Table Be) Required Moment of Resistance (Mr) From Table BelowProduct Approval M / 3/ • •• Mr required Moment Resistance` •• '. • • •• Symbol Mean Roof Height Roof Supe 15' 20' 25' 30' H ••6:0 •••••• Roof Slope 2:12 34.4 36.5 38.2 39.7 Restoring Moment due to Gravity • • • •42.2 Product Approval 3:12 32.2 34.4 36.0 37.4 Calculated • • •39:8 ' 4:12 30.4 32.2 33.8 35.1 W -:.5r3 3j.3 Tile Dimensions 5:12 28.4 30.1 31.6 32.8 • • • • 34.9 6:12 26.4 28.0 29.4 30.5 • • 42.4 7:12 24.4 25.9 27.1 28.2 • • 30.0 • : i •••. • • • • • 00 • ••... •••. •• • • • ••••.. •• •••••. • •0000• 00000 • ••••.• •...•• • •• •••. 'Must be used In conjunction with a Ilst of moment based tile systems endorsed by the Broward Count; Boardsf.Rulgis and:.... • Appeals. • • • For Uplift based tile systems use Method 3. Compared the values for F' with the values for Fr. If the F' values are greater than or equal to the Fr values, for each area of the roof, then the tile attadlment method is acceptable. Method 3 "Uplift Based Tile Calculations Per RAS 127" (P1: x L _ = x w: = ) - W: x cos 0 = Fr, Product Approval F' (P2:_xL_=Txw:= )-W: xcos 0=FProduct Approval F' (P3:_ x L - = x w: = ) - W: x cos 0 = F„ - Product Approval F' Where to Obtain Information Description Symbol Where to find Design Pressure P1 or P2 or P3 RAS 127 Table 1 or by an engineering analysis pre- pared by PE based on ASCE 7 ' Mean Roof Height H Job Site Roof Slope 0 Job Site Aerodynamic Multiplier X, Product Approval Restoring Moment due to Gravity M8 Product Approval Attachment Resistance M, Product Approval Required Moment Resistance Me Calculated Minimum Attachment Resistance , F' Product Approval Required Uplift Resistance Fr Calculated Average Tile Weight W Product Approval Tile Dimensions L = length W = width Product Approval All calculations must be submitted to the building official at the time of permit application. 15.40 INTERNATIONAL CODE COUNCIL FLORIDA BUILDING CODE - BUILDING, 5th EDITION (2014) Copyright to, or licensed by ICC (ALL RIOHTS RESERVED); sed by Eimer Palacio on Jun L 20I5 1032.12 AM pursuant to License Agreement. No further reproduction authorized. • r • DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES (RER) BOARD AND CODE ADMINISTRATION DIVISION NOTICE OF ACCEPTANCE (NOA) Adco Products, Inc. d.b.a. Royal Adhesives & Sealants, Inc. 4401 Page Ave. P.O. Box 457 Michigan Center, MI 49254 SCOPE: This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The documentation submitted has been reviewed and accepted by Miami -Dade County RER - Product Control Section to be used in Miami -Dade County and other areas where allowed by the Authority Having Jurisdiction (AHJ). This NOA shall not be valid after the expiration date stated below. The Miami -Dade Count Product Co el.. Section (in Miami -Dade County) and/or the AHJ (in areas other than Miami -Dade County) reserve:the rigff td have this product or material tested for quality assurance purposes. If this product or materialT.1.11$ to perf6 p.i the accepted manner, the manufacturer will incur the expense of such testing and the AHJ •my'immediately revoke, modify, or suspend the use of such product or material within their jurisdiction. RER fgsejas the;igkt to revoke this acceptance, if it is determined by Miami -Dade County Product Control Section that Alis prodtitt of material fails to meet the requirements of the applicable building code. ••••••••„. • • MIAMI-DADE COUNTY PRODUCT CONTROL SECTION 11805 SW 26 Street, Room 208 Miami, Florida 33175-2474 T (786) 315-2590 F (786) 315-2599 www.miamidade.gov/economv • This product is approved as described herein, and has been designed to comply with the F1or fluitding Code • including the High Velocity Hurricane Zone of the Florida Building Code. • •. ' :.,••• ••. . DESCRIPTION: Millennium One Step' Foamable Adhesive, Millennium One Step Green® Namable . . •••... . . ...•• . . •••.. . • Adhesive, Millennium PG -1 Low Viscosity Insulation Adhesive, Millennium PG -1 Pump Grade Adhesive, Millennium PG -1 Fleeceback Membrane Adhesive, Tri -Built One Step Millennium Foamable Adhesive, Tri -Built One Step Green Millennium Foamable Adhesive, FTR 601 PG & FTR 601. LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following statement: "Miami -Dade County Product Control Approved", unless otherwise noted herein. RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no change in the applicable building code negatively affecting the performance of this product. TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply with any section of this NOA shall be cause for termination and removal of NOA. ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall be done in its entirety. INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This NOA revises NOA No. 14-0102.01 and consists of pages 1 through 4. The submitted documentation was reviewed by Gaspar J Rodriguez. NOA No.: 16-0229.07 Expiration Date: 07/24/18 Approval Date: 03/24/16 Page 1 of 4 ROOFING COMPONENT APPROVAL Category: Roofing Sub-Categorv: Cements, Adhesives and Coatings Materials: Urethane SCOPE: This approves Millennium One Step' Foamable Adhesive, Millennium One Step Green® Foamable Adhesive, Millennium PG -1 Low Viscosity Insulation Adhesive, Millennium PG -1 Pump Grade Adhesive, Millennium PG -1 Fleeceback Membrane Adhesive, Tri -Built One Step Millennium Foamable Adhesive, Tri - Built One Step Green Millennium Foamable Adhesive, FTR 601 PG & FTR 601 made by Adco Products, Inc. dba Royal Adhesives & Sealants, Inc. as described in this Notice of Acceptance. The use of this acceptance is limited to those roof assemblies where Millennium One Step' Foamable Adhesive, Millennium One Step Green® Foamable Adhesive, Millennium PG -1 Low Viscosity Insulation Adhesive, Tri -Built One Step Millennium Foamable Adhesive & Tri -Built One Step Green Millennium Foamable Adhesive are specifically listed as an accepted component. . • ••.. • • ••••• Millennium One Step`" Foamable Adhesive, Tri -Built One Step Millennium Foamable Adhesive & FTR 601: PRODUCT DESCRIPTION: • •••.. • Property Standard Properties -•.. ...• ; • ...• 4 • Tensile Strength ASTM D 412 305 psi • • •' • • • •, • • � � 8.4 lbs./gal. Density (Component A) ASTM D 1875 9.7lbs./gal. • • • • •. ASTM D 2556 •, Density (Component B) ASTM D 1875 8.4 lbs./gal. • • • • Report Viscosity (Component A) ASTM D 2556 4,253.3 cP ;�-... :..... .. Viscosity (Component B) ASTM D 2556 5020 cP • • • • :.• Flexibility ASTM D 816 Pass @ 70°F •. • • • Water Absorption ASTM D 2842 0.56% Flame Spread Index ASTM E 84 10 Smoke Developed Index ASTM E 84 30 Millennium PG -1 Low Viscosity Insulation Adhesive, Millennium PG -1 Pump Grade Adhesive, Millennium PG -1 Fleeceback Membrane Adhesive & FTR 601 PG: Property Standard Properties Tensile Strength ASTM D 412 305 psi Density (Component A) ASTM D 1875 9.7 lbs./gal. Density (Component B) ASTM D 1875 8.4 lbs./gal. Viscosity (Component A) ASTM D 2556 223.2 cP Viscosity (Component B) ASTM D 2556 352.3 cP Flexibility ASTM D 816 Pass @ 70°F Water Absorption ASTM D 2842 Report Flame Spread Index ASTM E 84 10 Smoke Developed Index ASTM E 84 30 MIAMI.DADE COUNTY APPROVED NOA No.: 16-0229.07 Expiration Date: 07/24/18 Approval Date: 03/24/16 Page 2 of 4 •••• • • •••• ••: • • r w. Millennium One Step Green® Foamable Adhesive & Tri -Built One Step Green Millennium Foamable Adhesive: Property Standard Properties Tensile Strength ASTM D 412 780 psi Density (Component A) ASTM D 1875 9.71bs./gal. Density (Component B) ASTM D 1875 8.2 lbs./gal. Viscosity (Component A) ASTM D 2556 2,864 cP Viscosity (Component B) ASTM D 2556 3,256 cP Flexibility ASTM D 816 Pass @ 70°F Water Absorption ASTM D 2842 Report Flame Spread Index ASTM E 84 30 Smoke Developed Index ASTM E 84 15 Note: The preceding physical properties are presented at typical average values as determined by accepted ASTM test methods and are subject to normal manufacturing variation. Numerical ratings as determined by ASTM Test Method E-84 are not intended to reflect hazards presented by this or1I ry• other material under actual fire conditions. • • • : "' • EVIDENCE SUBMITTED: Test Aeencv FM Approvals Underwriters Laboratories, Inc. Momentum Technologies, Inc. Trinity I ERD MANUFACTURING LOCATION: 1. Chagrin Falls, OH • • • •• • •••Y• Test ••••• Test Identifier Specification • 3009610 Class 4450 Y • • • 1074/01 3024311 Class 4470 1d/01/06 • 3036182 Class 4470 • • d'7/M t(!9 ' • • •: • R20739 UL 790 1213Q/b9 : • •'': 03CA8935 ASTM E84 03/31/03 EX 13A3A Physical Properties 02/07/03 CX27H7A Physical Properties 09/28/07 CX27H7B Physical Properties 09/28/07 M31690.07.10 Physical Properties 07/07/10 A42900.11.12 Physical Properties 11/09/12 •••YYY •Y • oYYYY: Y •••YY • •••YY • 000000 LIMITATIONS: Millennium Adhesives shall have a quality control testing program by an approved independent listing agency having unannounced follow-up visits. Follow up test results shall be made available to Miami -Dade Product Control upon request. INSTALLATION: Millennium Adhesives shall be installed in strict compliance with the Roof Assembly Notice of Acceptance, and manufacturer's published literature. MIAMI.DADE COUNTY APPROVED NOA No.: 16-0229.07 Expiration Date: 07/24/18 Approval Date: 03/24/16 Page 3 of 4 BUILDING PERMIT REQUIREMENTS: As required by the Building Official or the applicable Building Code in order to properly evaluate the installation of this system. This Notice of Acceptance on its own cannot be used to obtain a building permit. LABELING: Millennium Adhesives shall be labeled in compliance with TAS 121 and shall bear the imprint or identifiable marking of the manufacturer's name or logo, city, state and following statement: "Miami -Dade County Product Control Approved" or the Miami -Dade County Product Control Seal as shown below. MIAMI•DADE COUNTY APPROVED END OF THIS ACCEPTANCE • • •• •.• • ••.••• •• .•••• ••••• ease• •••••• • •• •• • i••••• • • • • • • • •• • • •••. ••••• • • • • • ••••• ••••• •.• • • • • • i••••• ••• • •••••• 00000• •0000 • • • • ••••s ••s••• • • 00000• • • i •••••• NOA No.: 16-0229.07 Expiration Date: 07/24/18 Approval Date: 03/24/16 Page 4 of 4 Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNERS'S AFFIDAVIT OF EXEMPTION ROOF TO WALL CONNECTION HURRICANE MITIGATION RETROFIT FOR EXISTING SITE - BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES PERSUANT TO SECTION 553.844 F.S. To: Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores, FI 33138 Cory€roizc Re: Owners Name: /Yl Property Address: (D505 AI j 5 Oz ur Roofing Permit Number: Dear Building Official• I U&4 Pt �� certify that I am not required to retrofit the roof to wall connections of my building ause: -Te just valuation for the structure for purpose p rpose of ad valorem taxation is less than $300,000.00. Please attach proof of ad valorem taxation. o The building was constructed in compliance with the provisions of the Florida Building Code (FBC) or with the provisions of 1994 edition .i outh Florida Building Code (1994 SFBC) Date: °7 Signature Amkt p, bad Print Name State of Florida County of Dade The undersigned, being the first duly swom, deposes and says that he/she is the owner for the above property mentioned. Swom to and subscribed before me this (O day of Peilorie Notary Public, Sate of Florida at Large PkNotary Public State of Florida Katrina Cornish y� � My commission GO 014825 'i a Expires 07/24/2020 • When the just valuation of the structure for purpose of ad valorem taxation is equal to or more than $300,000.00, and the building was not construct SFBC. Then you must provide a building application from a General Contractor for the Roof to Wall connection Hurricane Mitigation. Revised on 5/21/2009 with FBC nor a 1994 Property Search Application - Miami -Dade County Page 1 of 1 Summary Report Property Information Folio: 11-2231-013-0590 Property Address: 10565 NE 2 CT Miami Shores, FL 33138-2002 Owner SAMUEL COMERFORD &W YORNET COMERFORD Mailing Address 10565 NE 2 CT MIAMI SHORES, FL 33138 Primary Zone 1000 SGL FAMILY - 2101-2300 SQ Primary Land Use 0101 RESIDENTIAL - SINGLE FAMILY : 1 UNIT Beds / Baths / Half 2 /2 /0 Floors 1 Living Units 1 Actual Area 1,635 Sq.Ft Living Area 1,299 Sq.Ft Adjusted Area 1,463 Sq.Ft Lot Size 8,625 Sq.Ft Year Built 1950 Assessment Information Year 2016 2015 2014 Land Value $180,349 $144,279 $103,258 Building Value $118,796 $120,493 $119,030 XF Value $2,879 $2,707 $2,742 Market Value $302,024 $267,479 $225,030 Assessed Value $228,417 $226,830 $225,030 Benefits Information Benefit Type 2016 2015 2014 Save Our Homes Cap Assessment Reduction $73,607 $40,649 Taxable Value Homestead Exemption $25,000 $25,000 $25,000 Second Homestead Exemption $25,000 $25,000 $25,000 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description FIRST ADD TO PASADENA PARK PB 6-82 LOT 12 & N1/2 LOT 13 BLK 14 LOT SIZE 75.000 X 115 OR 21241-4770/71 03 2003 1 Generated On : 2/28/2017 Taxable Value Information Previous Sale 2016 2015 2014 County Exemption Value $50,000 $50,000 $50,000 Taxable Value $178,417 $176,830 $175,030 School Board Exemption Value $25,000 $25,000 $25,000 Taxable Value $203,417 $201,830 $200,030 City Exemption Value $50,000 $50,000 $50,000 Taxable Value $178,417 $176,830 $175,030 Regional Exemption Value $50,000 $50,000 $50,000 Taxable Value $178,417 $176,830 $175,030 Sales Information Previous Sale Price OR Book -Page Qualification Description 06/03/2010 $327,500 27311-2869 Qual by exam of deed 03/01/2003 $250,000 21241-4770 Sales which are qualified 02/01/2001 $185,000 19523-1108 Sales which are qualified 09/01/1998 $125,000 18304-0054 Sales which are qualified The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp Version: http://www.miamidade.gov/propertysearch/ 2/28/2017 MiamiShoresills e 9 Building Department CONTRACTORS' REGISTRATION IF CONTRA FOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. V COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTORS TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: H CE Cf`� BUSINESS ADDRESS: q7b1 1 t) Filler, CITY ail 4411C1 PAT/is-mu Pt r ZIP BUSINESS PHONE: 6 '/ ) Y/ 4, 13 FAX NUMBER (Qsr./ ) S 6CD CELL PHONE ( ) QUALIFIER'S NAME: l QUALIFIER'S LIC NUMBER: RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY • STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 DIA r, NEY PETHER E -Z GENERAL & ROOFING CONTRACTORS INC 4751 NE 10THAVENUE OAKLAND PARK FL 33334 ISSUED: 06/28/2018 RICK SCOTT, GOVERNOR DISPLAY AS REQUIRED BY LAW SEQ # L16062 KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD The ROOFING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 DIAS, NEY PETHER E-2 GENERAL & ROOFING -C NTRACTORSINC 4751 NE 10TH AVENUE OAKLAND PARK FL 33334 ISSUED: 06/28/2016 DISPLAY AS REQUIRED BY LAW SEQ A L1606280000522 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2016 THROUGH SEPTEMBER 30, 2017 DBA: E Z GENERAL & ROOFING CONTRACTORS Business Name: INC Owner Name: NEY PETHER DIAS Business Opened:06/04/2003 Business Location: 4751 NE 10 AVE State/County/CertlReg:CGC1505586 OAKLAND PARK Exemption Code: Business Phone:754-368-0990 Receipt #:GOER L7 CONTRACTOR (GENERAL Business Type:CONTRACTOR) Rooms Seats Employees 1 Machines Professionals For Vending Business Only Vending Type: Tax Amount --------- -- ----- Transfer Fee ------ NSF Fee Penalty Prior Years Collection Cost Total Paid -- 0.00 _ _ _ 0...0.0.. _ _ 0_00._...._ _ _ 0 co -- 0.03- - 2-7700 21.000- BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2016 THROUGH SEPTEMBER 30, 2017 DBA: Receipt #'ROO5FING/SHEET METAL CONTRACTOR Business Name: INC GGENERAL & ROOFING CONTRACTORS Business Type: (ROOFING CONTRACTOR) i cJ Owner Name: NEY PETHER DIAS Business Location: 4751 NE 10 AVE OAKLAND PARK Business Phone:754-368-0990 Rooms Seats Employees 1 Business Opened:06/04/2003 State/County/CertlReg:CCC1325628 Exemption Code: Machines Professionals For Vending Business Only • Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 _ _ _ 0...0.0.. _ _ 0_00._...._ _ _ 0 co -- 0.03- - 2-7700 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT WHEN VALIDATED Mailing Address: NEY PETHER DIAS 4751 NE 10 AVE OAKLAND PARK, FL 33339 This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Receipt #WWW -15-00138416 Paid 07/12/2016 27.00 CERTIFICATE OF LIABILITY INSURANCE Date I 2/21/2017 Producer: Plymouth Insurance Agency 2739 U.S. Highway 19 N. Holiday, FL 34691 (727) 938-5562 This Certificate is Issued as a matter of Information only and confers no rights upon the Certificate Holder. This Certificate does not amend, extend or alter the coverage afforded by the policies below. / Insurers Affording Coverage NAIC # Insured: South East Personnel Leasing, Inc. & Subsidiaries 2739 U.S. Highway 19 N. Holiday, FL 34691 Insurer A: Lion Insurance Company 11075 Insurer B: Insurer C: Insurer D: Insurer E: Coverages The policies of Insurance listed below have been Issued to the Insured named above for the policy period Indicated. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate may be issued or may pertain, the Insurance afforded by the policies described herein is subject to all the terms, exclusions, and conditions of such policies. Aggregate limits shown may have been reduced by paid claims. INSR LTR ADDL INSRD Type of Insurance Policy Number Policy Effective Date (MM/DD/YY)_ Policy Expiration Date (MM/DD/YY) Limits GENERAL LIABILITY Commercial General Liability Each Occurrence $ Damage to rented premises (EA occurrence) $ Claims Made Occur Med Exp $ Personal Adv Injury $ General 3 aggregate limit applies per: Policy ❑ Project ❑ LOC General Aggregate $ Products - Comp/Op Agg $ AUTOMOBILE LIABILITY Any Auto All Owned Autos All Scheduled Autos Hired Autos Non -Owned Autos Combined Single Limit (EA Accident) $ Injury (Per Person) $ Bodily Injury (Per Accident) $ Property Damage (Per Accident) $ EXCESS/UMBRELLA LIABILITY Occur ❑ Claims Made Deductible Each Occurrence Aggregate A Workers Compensation and Employers' Liability Any proprietor/partner/executive officer/member excluded? No If Yes, describe under special provisions below. WC 71949 01/01/2017 01/01/2018 x I WC Statu- tory Limits I 1OTH- ER E.L. Each Accident $1,000,000 E.L. Disease - Ea Employee $1,000,000 E.L. Disease - Policy Limits $1,000,000 Other Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616 Descriptions of Operations/LocationsNehicles/Exclusions added by Endorsement/Speclal Provisions: Client ID: 92-67-619 Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. & Subsidiaries that are leased to the following "Client Company": E -Z General & Roofing Contractors Inc. Coverage only applies to Injuries incurred by South East Personnel Leasing, Inc. & Subsidiaries active employee(s), while working in: FL Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity. A list of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937-2138 or by calling (727) 938-5562. Project Name: NEY PETHER DIAS LICENSE NUMBER CCC1325628 AS QUALIFIER. ISSUE 02-21-17 (KR) Begin Date 11/9/2015 CERTIFICATE HOLDER CANCELLATION VILLAGE OF MIAMI SHORES BUILDING DEPARTMENT 10050 NE 2 AVE. MIAMI SHORES, FL 33138 , Should any of the above described policies be cancelled before the expiration date thereof, the issuing insurer will endeavor to mail 30 days written notice to the certificate holder named to the left, but failure to do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives. -414f1/‘..-04.41.40,- AccoR Q® CERTIFICATE OF LIABILITY INSURANCE DATE 0(M 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Pettineo Insurance Agency, Inc. 2430 E Commercial Boulevard Fort Lauderdale, FL 33308 CONTACT NAME: HONE AX . Ext). 954-493-9424 ([ C, No: 954-493-8968 A ADDREDREss: INSURER(S) AFFORDING COVERAGE NAIC d INSURER A: Arch Specialty Insurance Co. COMMERCIAL GENERAL LIABILITY INSURED E -Z General Roofing Contractors, Inc. D/B/A Precision Tech 4751 NE 10th Avenue Fort Lauderdale, FL 33334 INSURER e : AGL002760401 INSURER C: 07/18/17 INSURER D: $ 1,000,000 $ 100,000 INSURERE: CLAIMS -MADE X INSURER F: PREMISES (Ea occuRENTErrence) COVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IXP TR TYPE OF INSURANCE tANSD DDL SWVD POLICY NUMBER IMMM/DOIYYYYUBR POLICY Y) IMMILDI POLICY Y) LIMITS X COMMERCIAL GENERAL LIABILITY AGL002760401 07/18/16 07/18/17 EACH OCCURRENCE $ 1,000,000 $ 100,000 CLAIMS -MADE X OCCUR PREMISES (Ea occuRENTErrence) MED EXP (Anyone person) $ 10,000 PERSONAL & ADV INJURY $ 1 000,000 GEN'L AGGREGATE LIMIT APPLIES POLICY i X1 PROJECT OTHER: PER: LOC GENERAL AGGREGATE $ 2,000,000 $ 2,000,000 $ 0 PRODUCTS - COMP/OP AGG AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY _ SCHEDULEDBODILY AUTOS NON -OWNED AUTOS ONLY(Per COMBINED SINGLE LIMB (Ea accident) $ 0 BODILY INJURY (Per person) $ 0 ) $ 0 PROPERTY DAMAGE accident) $ 0 $ 0 UMBRELLA UAB EXCESS LAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ 0 AGGREGATE $ 0 DED RETENTION $ 0 $ 0 WORKERS COMPENSATION AND EMPLOYERS' LIABILITYY / N ANY PROPRIETOR/PARTNER/EXECUTIVE f OFFICER/MEMBER EXCLUDED? I I (Mandatory In NH) DES, describeunder DESCRIPTION OF OPERATIONS below N / A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 0 E.L. DISEASE - EA EMPLOYEE $ 0 E.LDISEASE-POUCYLIMIT $ 0 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 5 more apace Is required) License # CCC 1325628 CATS HOLDER I Village of Miami Shores Building Department 10050 NE 2 Ave Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 4'll/J ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD